Healthcare Provider Details

I. General information

NPI: 1033851241
Provider Name (Legal Business Name): CENTER FOR IMPLANT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28124 ORCHARD LAKE RD STE 100
FARMINGTON HILLS MI
48334-3760
US

IV. Provider business mailing address

28124 ORCHARD LAKE RD STE 100
FARMINGTON HILLS MI
48334-3760
US

V. Phone/Fax

Practice location:
  • Phone: 352-213-1646
  • Fax:
Mailing address:
  • Phone: 352-213-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. YUKSEL ERPARDO
Title or Position: PRESIDENT
Credential: DDS, PHD
Phone: 352-213-1646